The Norwood procedure using a right ventricle–pulmonary artery conduit: Comparison of the right-sided versus left-sided conduit position

Abstract

The right-sided conduit is a safe technique and has improved 30-day and overall post-stage II survival compared with that seen with the classic Norwood procedure. The right ventricle-pulmonary artery conduit is associated with central pulmonary artery stenosis but good development of the branch pulmonary arteries and preservation of ventricular function. The right-sided conduit significantly reduces cardiopulmonary bypass times at stage II.

Right ventricle-to-pulmonary artery shunt related complications after Norwood procedure☆

“…Distal-end stenosis can be associated with the central pulmonary artery stenosis, a high incidence of which (50-85%) after the RV-PA shunt was described in previous studies [11,13]. Pulmonary homograft patch augmentation of the pulmonary confluence at the shunt insertion, which was performed in all our children at the time of NP or pericardial patch enlargement perform by other surgeons [12,16], might result in less frequent central pulmonary artery stenosis during late follow-up.…”

“…However, we did not observe any complications, which can be related to the more intensive hypoxemia or a high hematocrit value. Because of early hypoxemia, some centers now perform earlier second-stage procedure [5,[10][11][12]. The mean age of the children at the time of second-stage palliation in the present study was 7.0 months, and only five children were admitted earlier than scheduled due to cyanosis and underwent second-stage procedure before the fifth month of age.…”

“…Despite lower Qp:Qs ratio, better development of the branch PAs after NP with RV-PA shunt than after NP with BT shunt was widely reported [11][12][13][14]21]. In our opinion, this phenomenon is caused by two reasons: more centrally located distal end of the shunt, which promotes more symmetrical growth of the right and left PA, and more pulsatile blood flow (the higher pulse pressure in the shunt).…”

“…Concerns remain about the consequences of the ventriculotomy and diastolic flow regurgitation. Lower Qp:Qs causes early cyanosis, and the children may require earlier second-stage procedure [5,[10][11][12]. Some centers report also about an increased number of surgical interventions associated with the RV-PA shunt between the first and second stage of palliation [10,13].…”

Outcome of Norwood operation for hypoplastic left heart syndrome

“…Currently, more and more units are opting for it especially one with less volumes with the hope of less interstage mortality. [3][4][5][6][7][8].…”